Questions & Answers on Psychiatric Medications

Tadao Ogura, M.D.


How Does a Doctor Choose the Right Medications for Me?

For the majority of doctors, the process is largely one of trial-and-error. Do not be alarmed, however, - this does not mean that doctors are guessing about medications at random or using patients as guinea pigs. There are many established and "official" guidelines on how to pick appropriate medications and dosages for different psychiatric conditions. The "PDR" or "Physician's Desk Reference" that was mentioned earlier, is just one of these guides, although not specific to psychiatry.

The only problem is that these guidelines are based on the assumption that all people are created equal and do not address individual differences in any detail. Thus, the "trial-and-error" part comes in, because the reaction a particular individual may develop towards a particular medicine and dosage is often very different.

Consequently, patients must be monitored closely while changing their medications and their dosages until the best medications and dosages are found. In some cases, the established standards may be the right one for you or a minor tweak may be all that is needed. Unfortunately, however, many other people may need a few trial-and-error cycles before the right medications are found, if ever.

Sometimes, general practitioners, or inexperienced psychiatrists, use the above-mentioned guidelines to prescribe medications, and do not go through the process of checking and tweaking the medications to make sure they are the right ones or the right dosages for the patients.

Even if the medication is the right one initially, it must be still closely monitored, as your body (and brain) adapts to the medication, and starts to show various signs of mismatch in type and/or dosage- many physicians, even experienced ones, often skip this very important step. This is when trouble often occurs.

In my own practice, I use another technique in addition to the established standards that have been giving me almost 90% accuracy on the first try with my patients. This technique is a variation of the "Bi-Digital O-ring Test," developed by Dr. Yoshiaki Ohmura of Japan. I will discuss this technique in more detail later.

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